PNHP Experts who can speak on individual mandates for health insurance and the Clinton health plan

Physicians for a National Health Program (PNHP) has physicians available for comment on Sen. Hillary Clinton's and other Democratic presidential candidates' health care proposals.

The leading Democratic presidential candidates' (Clinton, Edwards, and Obama) health care proposals would require everyone (or every child, in the case of Obama) to carry health insurance and offer federal subsidies to help reduce the cost of private health insurance. The centerpiece of their plans is an "individual mandate," requiring everyone to buy health insurance, and an "employer mandate," mandating that employers help cover workers. The following experts can comment:

DON MCCANNE, M.D., is senior health policy fellow of Physicians for a National Health Program. He said: "The administrative complexities of refundable tax credits and means-tested premium caps would still leave many without coverage. Coverage will never be universal unless it is truly automatic for everyone. If we are going to use the tax system to pay for health care anyway then why should we waste funds on the profoundly inefficient system of segregated private health plans? A universal risk pool that is equitably funded through the tax system is the most efficient and least expensive method of ensuring comprehensive coverage for everyone."

Dr. McCanne continues: "Neither Clinton's nor Obama's plans get us to universal coverage. Clinton claims that her plan is going to get universal coverage because it has an individual mandate, but that's been tried and failed in several states. ... Obama claims his plan gets universal coverage by making coverage affordable for people, but if you look at his proposals, there's very little substance to it."

DAVID HIMMELSTEIN, M.D., is associate professor of medicine at Harvard Medical School. He said today: "Hillary Clinton is combining two failed Massachusetts plans: the [former Gov. Michael] Dukakis plan, which fell apart 20 years ago, and the [Gov. Mitt] Romney plan, which is in the process of falling apart. Clinton is advocating the Marie Antoinette approach to health care: 'Let them buy their own coverage.' She is attempting to force middle class families to buy coverage without making it affordable. Clinton wants to keep the private insurance industry in the middle of the system." Himmelstein is co-founder of Physicians for a National Health Program. (617) 665-1032, info@pnhp.org, http://www.pnhp.org

QUENTIN YOUNG, M.D., is national coordinator of Physicians for a National Health Program. He said: "It's always ironic to hear Clinton talk about standing up to the insurance companies. She'd tried to work them into her plan [in the mid-'90s], which is a large part of why it failed. The biggest insurance companies actually backed her plan for a time while the smaller ones opposed it." (312) 782-6006, info@pnhp.org, http://www.pnhp.org

DONALD FREY, M.D., is Roland L. Kleeberger Chair in the Department of Family Medicine at the Creighton University School of Medicine in Omaha, and is a member of Physicians for a National Health Program. He has written and spoken extensively about wasted overhead in American insurance companies, and says other countries spend less money to get far better, measurable health care outcomes. He said: "Though well intended, the Clinton plan leaves an enormously wasteful private insurance system intact, ensuring that increased coverage will only come at extremely high cost. Federal dollars will be funneled through high-overhead private companies, ensuring that millions of tax dollars that could be going to pay for health care will actually wind up as enhanced corporate bottom lines. In many ways, the plan is far more a corporate welfare program than a social welfare plan." News Contact: Kathryn Clark, kathrynclark@creighton.edu, (402) 280-2864 (9/19/07, digital50.com)

Hillary Clinton's proposal "preserves existing health insurance," and includes the responsibility of individuals "to get and keep insurance" through the current private insurance market, or through a "Health Choices Menu" of private FEHBP-type plans, or through a Medicare-type public program.

Thus her proposal is an individual mandate to purchase private insurance that is no longer affordable for average-income individuals, or to purchase a public plan that will be even more expensive because of adverse selection.

To make the plans affordable for individuals, she would use a combination of refundable tax credits and a cap on premiums at a percentage of income. Assuming that the plans would provide adequate benefits and adequate protection against financial hardship, the increased spending through the tax system would be exponentially more than the estimates in her plan. And most of the proposed savings to pay for these increases are largely nebulous, and some of those measures would actually increase costs.

Further, the administrative complexities of refundable tax credits and means-tested premium caps would still leave many without coverage. Coverage will never be universal unless it is truly automatic for everyone.

If we are going to use the tax system to pay for health care anyway then why should we waste funds on the profoundly inefficient system of segregated private health plans? A universal risk pool that is equitably funded through the tax system is the most efficient and least expensive method of ensuring comprehensive coverage for everyone.

Many will try to contrast the differences in the Clinton, Obama and Edwards proposals, but they are all basically the same. In spite of their rhetoric, they have each made the protection and enhancement of the private insurance plans a higher priority than patients.

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Physicians for a National Health Program is an organization of 15,000 American physicians advocating for non-profit national health insurance. PNHP has chapters and spokespersons across the country. For local or national contacts, call (312) 782-6006.